Chiropractic hospitals in America: A case study of the Bakkum Hospital (1936-1950).

OBJECTIVE: The purpose of this article is to relate the story of the Bakkum Chiropractic Clinic and Hospital and offer evidence regarding the lost days of chiropractic hospitalization and inpatient care. DISCUSSION: The number of chiropractic facilities offering inpatient care peaked in the period between World Wars I and II. Little information is available about the vast majority of these facilities. One of them was the Bakkum Chiropractic Clinic and Hospital in Waukon, Iowa. The proprietor was Roy C. Bakkum, DC; he and his wife, Jessie H. Bakkum, DC, opened their 30-bed facility in 1936. Patients received hole-in-one chiropractic adjustments, rest, and nursing care at this facility. Dr Roy Bakkum not only envisioned chiropractors as true primary caregivers but also implemented that vision to the best of his ability. He saw chiropractic as the principal type of health care that the vast majority of people should receive, even as inpatients; instead of being the usual and customary type of hospital care, pharmaceutical and surgical intervention would be called on only as needed. Mainly because of economic pressures, the Bakkums' facility closed in 1950. CONCLUSION: The Bakkum Chiropractic Clinic and Hospital may have been fairly typical of small chiropractic facilities offering inpatient care. Like many private hospitals of various kinds, the Bakkums' facility closed in the post-World War II period, primarily because of economic and political losses. This article traces the history of one chiropractic facility to add historical context to chiropractors' long struggle to own and operate chiropractic hospitals.

The Bakkum Chiropractic Clinic and Hospital.

The number of chiropractic facilities that offered in-patient care peaked in the period between World Wars I and II. Little information is available about the vast majority of these facilities. One of these was the Bakkum Chiropractic Clinic and Hospital in Waukon, Iowa. The proprietor was Roy C. Bakkum, D.C., who along with his wife, Jessie H. Bakkum, D.C., opened this thirty bed facility in 1936. The only therapeutic intervention that the majority of patients received at this facility was hole-in-one (HIO) adjustment. Unfortunately, mainly because of economic pressures, the facility closed in 1950. The Bakkum Chiropractic Clinic and Hosptial may have been fairly typical of the small chiropractic facilities that offered in-patient care. Most of them closed in the post-World War II period, mostly due to economic difficulties. Dr. Roy Bakkum not only had the vision of chiropractors as true primary care-givers, but tried to implement that vision to the best of his ability. He saw the chiropractic adjustment as the main therapeutic intervention that the vast majority of people should receive, even as in-patients. Radical allopathic or surgical intervention would have only been called upon as needed, rather than being the usual and customary primary care that is currently the norm.

The communicating branch of the lateral plantar nerve: a descriptive anatomic study.

Since the communicating branch of the lateral plantar nerve has been implicated as a factor in the etiology of Morton's neuroma, a painful perineurofibrosis of a common plantar digital nerve, this project was designed to investigate the anatomy of this communicating branch. Both feet of 40 embalmed human cadavers were dissected to show the frequency of occurrence and anatomical variation of the communicating branch. The communicating branch was present in 66.2% of the feet we studied with no large gender-based differences. Branches occurred bilaterally in 52.5% of cadavers, while 27.5% had branches unilaterally. The occurrence of this branch does not correlate well with the likelihood of development of Morton's neuroma. Differences in diameter of the communicating branch ranged from less than 0.5 mm to as large as the common plantar digital nerves themselves, about 2 mm. The presence or absence of the communicating branch made no qualitative difference in the diameters of the common plantar digital nerves. There were 60.4% of the communicating branches in this study that had a typically-described orientation, arising more proximally in the foot from the fourth common plantar digital nerve, while 39.6% of the branches had a reversed orientation, arising more proximally from the third common plantar digital nerve. These reversed branches had a more oblique orientation when compared to the classic branches. Other anatomical variations were noted, including accessory branches that attached to deeper structures in the foot. These data form a basis for further research into the etiology of Morton's neuroma and improved surgical techniques for correcting this condition.

Gross anatomic evidence of partitioning in the human fibularis longus and brevis muscles.

Evidence from a variety of studies suggests that many mammalian muscles are partitioned with respect to their architecture and innervation. Each of these specific muscle subvolumes is innervated by an individual muscle nerve branch, contains motor unit territories with a unique array of physiological attributes and has been known as a neuromuscular compartment or segment. This gross anatomic study investigated for evidence of neuromuscular segmentation in human fibularis (peroneus) longus and brevis muscles. Forty-three legs (24 left, 19 right) from embalmed adult cadavers were dissected. Any architectural segment within these muscles were identified. The specific innervation patterns of these muscles were also described. The fibularis longus muscle was consistently found to have connective tissue partitions that separated it into four parts: anterior superficial, anterior deep, posterior superficial, and posterior deep. The innervation pattern of this muscle was consistent with the segments defined by the connective tissue partitions. There were consistently four primary motor branches, each supplying a specific portion of the fibularis longus muscle. While a typical branching pattern was recognized, there was some variability as to the order of these branches as they originated. The fibularis brevis muscle was consistently found to have a central connective tissue partition that separated it into two portions: anterior and posterior. In 91% of the fibularis brevis muscles, there were two primary motor branches, one for each of the two segments of the muscle. In the other 9%, only one primary motor branch supplying the muscle could be identified.

gamma-Aminobutyric acid and somatostatin immunoreactivity in the visual cortex of normal and dark-reared rats.

Our previous single unit and ultrastructural studies of visual cortex of dark-reared rats revealed an impairment of intracortical inhibitory mechanisms [2,3,5]. Neurochemical changes in inhibitory neurotransmitter and/or neuropeptides, such as gamma-aminobutyric acid (GABA) and somatostatin (SS), respectively, may contribute to the observed alterations. The present study was designed to measure GABA and SS alterations in the visual cortex of the same dark-reared preparation, as possible neurochemical correlates of the changes seen both physiologically and anatomically in previous companion studies. In the present investigation the mean densities of GABA- and SS-immunoreactive neurons in area 17 of dark-reared rats were determined and compared to the density of those of rats reared in normal lighting conditions. Dark-rearing resulted in a significant decrease in the density of GABA-immunoreactive neurons in all cell layers of area 17 of the rat visual cortex; not limited to the thalamorecipient layer(s). There was also a higher mean density of total cortical cells in dark-reared animals. No differences, however, were seen in the density of SS-immunoreactive neurons. The alterations of GABA-immunoreactive neurons in all cortical layers agree with the altered synaptic ultrastructure and physiological responses seen in all cortical layers as reported in our previous companion studies. Taken together, these studies further support the notion of a deficit in intracortical inhibitory mechanisms in the visual cortex of dark-reared adult rats.

The effects of transforaminal ligaments on the sizes of T11 to L5 human intervertebral foramina.

OBJECTIVE: This study was designed to determine the effects of the presence of transforaminal ligaments (TFL) on the superior-to-inferior dimension (SI) and anterior-to-posterior dimension (AP) of the compartment containing the ventral ramus of the spinal nerve (VR) in the intervertebral foramen (IVF). DESIGN: Four lumbar spines, including T12 and in one case T11, were obtained from embalmed cadavers and carefully dissected to expose the contents of the IVF. All ligamentous structures in the vicinity of the IVF were preserved. The greatest SI and AP of each IVF were measured. When present, TFL help define a compartment at the exit zone of the IVF that contains the VR. The SI and AP of these compartments were also measured. RESULTS: Of 49 IVF examined, at least one TFL was present in 35. In the 34 IVF with horizontally oriented TFL, the mean SI of the compartments for the VR was 31.5% smaller than that of the IVF (one-way ANOVA, p < .01). No significant differences were seen between the AP of the IVF and compartments for the VR in the levels with vertically oriented TFL (n = 11). CONCLUSIONS: TFL were found to be present in 71% of lower thoracic and lumbar IVF. If TFL were present, the SI of the compartment containing the VR in the IVF was significantly decreased (mean = 31.5%). This finding suggests that often there may be less space at the exit zone of the IVF for the ventral ramus than traditionally thought, which could contribute to the incidence of neurological symptomatology in this region, especially after trauma or degenerative changes.

The effects of dark-rearing on the electrophysiology of the rat visual cortex.

Our previous two studies have shown that dark-rearing affects the morphology and chemistry of adult rat primary visual cortex (area 17). In this study we demonstrate correlated physiological alterations with single unit recordings in the same preparation. Rats were raised from birth in either 14 h light/10 h dark (Lt/Dk) or in total darkness (Dk). At the age of 3 months, single units were recorded in area 17 of both groups. The cortical cells of Dk animals showed significantly more spontaneous activity during ambient lighting. The mean rate of randomly appearing spontaneous activity was greatly increased in Dk animals. Moreover, many cells in Dk animals also exhibited a particular type of spontaneous activity which occurred as 'bursts' of spikes, i.e. quantified groupings of fast firing spikes, separated by randomly appearing spontaneous activity. The mean number of bursts per min seen in Dk animals was also significantly more than any such activity seen in Lt/Dk animals. Visual stimuli consisted of white or dark bars moving with different orientations and directions at slow and fast speeds, and full field flashes. In response to moving stimuli, notably fewer cells were orientation- or direction tuned in dark-reared animals, and when they did respond to moving bar stimuli, the responses were of relatively longer duration. The pathologically high spontaneous activity rate, as well as lack of tuning and relatively prolonged duration of responses to moving stimuli indicate that intracortical inhibitory mechanisms are seriously compromised in both the unstimulated and stimulated states and is in agreement with our previous findings (Bakkum, B.W., Port, J.D., Cohen, R.S. and Benevento, L.A., Soc. Neursci. Abst., 15 (1989) 797) of a decreased number of synapses and GABA-containing cells in the visual cortex of the same preparation. Other evidence suggests that there may be a decrease in stimulus-bound excitatory drive. Significantly fewer cells in Dk animals were excited by all visual stimuli, and responses elicited by flashes had relatively longer 'on' latencies, relatively shorter durations, and were generally weaker. This may correlate with our finding of a significantly smaller number of perforated postsynaptic densities in the cortex of the same preparation (Bakkum, B.W., Benevento, L.A. and Cohen, R.S., J. Neurosci. Res., 23 (1991) 65-80).

Effects of light/dark- and dark-rearing on synaptic morphology in the superior colliculus and visual cortex of the postnatal and adult rat.

Several synaptic parameters, previously shown to undergo alterations with changes in the internal and external environment, were examined in the visual system of light/dark- and dark-reared postnatal and adult rats. Animals were raised in either 14 hr light/10 hr dark (Lt/Dk) or in total darkness (Dk). The specific synaptic parameters in the superficial layers of the superior colliculus (SC), visual cortex (laminae II/III and IV) (VC), and, as control, the auditory cortex (laminae II/III and IV) (AC), examined during the postnatal period (i.e., postnatal days 7, 14, 21, and 28) and in the adult (i.e., day 56) included: 1) mean number of synapses, 2) mean synaptic length, 3) percentages of perforated postsynaptic densities, 4) percentages of asymmetric and symmetric synapses, 5) percentages of dendritic, spinous, and somatic synapses, and 6) percentages of synapses with positive, negative, or no curvature. Developmental patterns in rats reared in normal lighting conditions were noted. Specifically, in the SC and VC of Lt/Dk animals, the number of synapses increased up to postnatal day (PND) 21 and then decreased; no significant changes in the mean number of synapses between PND = 28 and 56 were detected in any of the areas examined. Changes in synaptic length in the SC and VC were not observed during postnatal development of in the adult in any of the aforementioned brain areas. Low percentages of postsynaptic densities (PSDs) were found at all time points and in all brain areas during the postnatal period. Increases in perforated PSDs were seen at PND=56 compared to PND=28 in the VC. In the VC and AC, there was a decrease in symmetric synapses with age. Asymmetric synapses were prevalent in all brain areas at PND=28 and 56. Dendritic synapses predominated in the SC, while spinous synapses were the preponderant type in the VC and AC during postnatal development and in the adult. A decrease in the percentage of spinous synapses in the SC was observed at PND = 56 vs. PND=28. A decrease in the percentage of negatively curved synapses with age and a trend toward a concomitant increase in the percentage of positively curved synapses were seen in all brain areas during development and in the adult. Quantitative analyses of the SC and VC tissues examined from all postnatal animals demonstrated no significant differences between Lt/Dk and Dk animals in all the synaptic parameters measured.(ABSTRACT TRUNCATED AT 400 WORDS)